gms | German Medical Science

Background: Medication plans (MP) are instruments to document the complete medication of patients to improve the medication safety. Since October 2016, patients in Germany taking at least three long-term medications are entitled by law to receive a MP in a nationwide uniform layout (BMP).

Objective: To analyze the prevalence and quality of MP of patients admitted to a community hospital.

Methods: A four-month observational cross-sectional study was conducted in a large community hospital in Southwest Germany. Accountable and responsive patients were included in the study. In a structured patient interview, their current medication was queried and, if available, compared to their written medication list. Subsequently, their updated medication list was analyzed for medication errors (drug-drug interactions, inappropriate dosages, wrong/missing directions for intake) using RpDoc® (version 4.2) and the ABDA-database (status 10/2017). Patient’s data was anonymized and stored in a Microsoft Access database (version 2003). Statistical analysis was performed using SAS® Enterprise Guide (version 7.11).

Results: In total, 638 patients were enrolled in the study (53% male, mean age 61.5 years). On average, patients took 4.8 long-term medications. 424 out of the 638 patients (66.5%) took at least three long-term medications and were eligible to receive a BMP. 306 out of the 424 patients (72.2%) claimed to have any kind of a medication list. Only 240 patients had a written medication list available at their hospital admission. In a multivariate logistic regression analysis, increasing age and increasing number of medications revealed a significant impact (p < 0.0001) on the probability that a patient owns a medication list. Further, the origin of the medication lists was analyzed. In 19.5% of the MP, the document was created during a former stay in a hospital. Only 55.8% of the medication lists were created by physicians outside the hospital. In 24.6% of the cases patients compiled their medication lists by themselves.

Only 57 out of 240 (23.8%) available medication lists matched the BMP layout. In the 240 available medication lists, errors were observed quite frequently: 35.0% had wrong drugs recorded or drugs were missing. MP older than 120 days showed a significantly higher rate of missing medications (p=0.002). Information on the directions for intake, indications and dosage forms were missing in 95.8%, 92.1% and 54.2% of the cases, respectively. Only 3 out of 240 available medication lists (1.3%) were complete and without errors. All updated medication lists were analyzed for drug-drug interactions and in total 1214 drug-drug interactions were discovered. In 80.0% of the 424 patients entitled for a BMP, at least one drug-drug interaction was observed.

Discussion: Our study investigated the availability of MP and their quality in a large and representative cohort of 638 patients. Superficially, the prevalence of the MP seems to be acceptable with 72.2%. However, only 56% of the patients were carrying their MP when they entered the hospital and only 23.8% of the available MP matched the BMP layout. Further, about a quarter of the MP were compiled by the patients and not by any healthcare professional. These shortcomings might be explainable by the fact, that the BMP became just recently mandatory and neither patients nor physicians have fully understood their rights and obligations regarding the BMP.

Even more concerning, the overall quality of the investigated MP is bad. Less than 2% of the MP were without complaint. More than 90% of the MP were incorrect and/or incomplete. Less than a quarter matched the BMP layout. In 80% of the MP at least one drug interaction was discovered. The rate of medication errors was not significantly different in patients with a MP compared to patients without a MP. It might be speculated, that the MP is currently considered by the physicians as a necessity and storage place for patients medication, but the medication itself is not checked for medication errors. In consequence, patients might not benefit today from the availability of a MP as much as they could.

Implication: Our study revealed new insights on the status quo of the BMP. Although many patients own any kind of medication list, most lists do not match the legal requirements of the BMP layout and are not available, if required. The pure existence of a MP does not necessarily guarantee a safe medication process as the majority of MP was inaccurate. An eye should be kept on younger patients and patients with only a few medications as they most likely don't even have a medication plan. More efforts are required to keep existing MP up to date, to apply the validated nationwide BMP layout and to use the updated BMP to check for medication errors.